We have had to fight our health insurance company following the births of both kids. AJU5 spent a week in the NICU due to infection during labor and delivery, and AJU6 had a NICU doctor present at delivery due to fetal distress (his heart rate dropped in half). I have a network OB and delivered both of them at a network hospital. I had no idea that someone taking care of them would not be in-network when AJU5 was born. Then, I had no idea that it was even a NICU doctor when AJU6 was born.
It turns out that all of the NICU doctors at our hospital are out of network! That just was a complete shock to me when AJU5 was born. We got a letter from the doctors group the day I was discharged after AJU5 was born informing us of this. They said they would work with our insurance, but I don't know what they mean by "work." I had to call them MANY times with AJU5 to get things down to where they should be. Initially they wanted us to pay everything at the out-of-network rate. This would be more than twice our in-network out of pocket by the end since some things were still in-network (like the actual hospital bill). Eventually I got it so we paid less than $50 more than our max in-network out of pocket, and I was content.
So, when AJU6 was born and we got a similar letter in the mail, I was ready for a fight. I finally realized why I recognized the second doctor in the room when he was born since he was one of AJU5's doctors as well. But, I had originally thought it was another OB, not a NICU doctor. We got the first bill - about $750 for him to be in the room while AJU6 was born (i.e. about 30 minutes). We are fairly certain he didn't even tough AJU6 after he was born since he was perfectly fine. Well, since that is less than our out-of-network deductible, insurance wanted us to pay all of it. So, I called and got it reviewed. Then, they wanted us to pay about $375 dollars - $350ish that wasn't "customary" and then 20% of the remaining amount. Today I called and got them to review it again.
For the first time in all of this, I had a very nice lady who knew some things. She looked at our plan and saw that in the case of ER visits, etc. that they will pay 80% of whatever is billed. Since this was an emergency situation, she is having them review it under this clause. Hopefully it will work!
If we have three kids, I am just praying that there are no out-of-network issues to deal with!
6 comments:
Since we have the same insurance, hospital, and OB group, this info is good to know! Can't believe the NICU Dr.'s aren't In-Network that's retarded! We got the new HSA this year along with the new health plan with no co-pays so we'll see how it goes with that.
what a headache!
Wow, what a mess! And to have to deal with postpartum... totally cruel.
I am so very intimidated by insurance companies, and by medical bills. Luckily we didn't have to deal with any of that, but I was still ASTOUNDED when the itemized bill (pre-insurance) came to our house: roughly $30K for my medially necessary c-section and subsequent stay.
It's a scary thing! Sounds like you have it all handled though. I'm crossing my fingers that the emergency clause works!
Ugh. What a headache. It seems odd to me that a hospital can be in-network, yet supply no NICU doctors in-network. Something does not add up there.
We have had so many insurance woes with the deliveries of our children, that my husband started calling our insurance company and adding the new family member from the hospital, the day they are born! I'm not kidding. That little call made a world of difference for the last 2 births.
Good luck to you
Grrr. So annoying. Our hospital's anesthesiologists are out of network, so we got a bill for my epidural! All we had to do was send in a claim form and it was covered, but we both nearly passed out when we saw tht bill!
I cannot stand this kind of thing! Are you seriously supposed to be asking about networks while you are in labor? I hope you get it all sorted out easily.
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